Increasing Awareness of Patient Access to Physical Therapy in Texas

It might surprise you to know patients’ rights when it comes to access to physical therapists.

Physical trainer helping a patient with equipment

The American Physical Therapy Association (APTA) describes physical therapists as “movement experts who specialize in therapy techniques, assistive devices, massage, electrotherapy, exercises as well as education and training to help patients of all ages develop, regain, or maintain their physical abilities and improve the quality of their daily lives.”

Traditionally, physical therapists provide patient care as part of the larger healthcare team, working in collaboration with primary care physicians, surgeons, medical specialists, and other health care professionals.

They usually start by performing a physical examination to gain a better understanding of your impairments and how they may be impacting your function. From there, they may use a combination of the following as part of your treatment plan:

  • Strengthening
  • Stretching
  • Balance training
  • Hands-on manual therapy techniques

We spoke with Gary Kearns, ScD, PT about the current state of physical therapy accessibility in Texas, which may come as a surprise.

Kearns is an Assistant Professor in the Doctor of Physical Therapy Program at TTUHSC School of Health Professions.

Direct Access to Physical Therapy

Gary Kearns, ScD, PT

Gary Kearns, ScD, PT

Kearns begins by explaining how the Texas House Bill 29, which was passed in November of 2019, allows patients to see physical therapists without a referral from a doctor or a specialist.

“It is a great thing, but we’re going on three years and many people aren’t aware of it,” he says.

Prior to 2019, before Texas patients had direct access to physical therapy, one could visit a physical therapist directly, however the physical therapist was only allowed to provide an assessment, but no treatment. With the passing of HB 29, patients can now visit physical therapists directly, without a physician or specialist referral, and receive treatment if necessary.

“You could come see me and I could assess you, but I couldn’t treat you. Which begs the question, how direct is that access really?” Kearns says.

How Direct Access to Physical Therapy Changes the Process

Direct access for physical therapy is intended for patients with muscle and joint issues that aren’t related to a larger medical condition.

So if a patient comes into a clinic for physical therapy with no referral, the first step is to screen  them and make sure they are an appropriate candidate for physical therapy. If the issue falls outside of what a PT is trained and allowed to treat, the patient would then be referred to a physician or specialist.

“If somebody were to come directly to us thinking the muscles or joints in their back were the source of pain and we determined that wasn’t the case, we would then facilitate a referral back to their physician to figure out what is going on,” Kearns says.

“Let’s be honest, what type of patient is going to come and see a physical therapist for direct access? If you get in a car accident and break your arm, your first instinct won’t be to see a physical therapist, it will be to go to an emergency room or physician,” he says. “This [direct access] is best for people who have a minor recurring injury or issue, these are the patients who can bypass the referral process to receive care quicker.”

“Texas was one of the later states to get [direct access to physical therapy], and there can be considerable cost savings in bypassing the medical side of things and going directly to see a physical therapist,” he says.

Kearns reiterates that severe and serious injuries that require the care of a physician can still be referred to physical therapy after seeing a physician.

“It’s the people who have recurring injuries who have been through it before,” he says. “They are good candidates to bypass the physician referral for physical therapy.”

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